Thursday, February 26, 2015

I quote from the Washington Postarticle that is the source of the graph:

Measles killed 82,100 children under age 5 in 2013, ranking the disease at No. 7 on the list of the top causes of child death, according to recent statistics from the Global Burden of Disease study published in the Lancet. Lower respiratory infections like pneumonia were the number one killer, followed by malaria, diarrhea, nutritional deficiencies, congenital defects and meningitis. More small children died from measles in 2013 than died from drowning, road injuries or aids.

I suppose the good news is that diarrhea is less lethal than it once was.

More than 80,000 little kids dying of measles in 2013 is an indicator that people carrying the disease are still going to be coming to the USA frequently. It is important that we keep up the immunizations to a very high level to maintain herd immunity. That way, even if a foreign visitor with measles arrives or a U.S. traveler with a compromised immune system returns to this country with measles, the disease won't spread. Incidentally, parents protecting their children with the MMR vaccine have the benefit that their child will not suffer from measles -- a potentially fatal disease. Moreover, the kid won't get mumps nor German measles.

By the way the huge death toll in developing countries from pneumonias, malaria, diarrheal disease, malnutrition and other causes is an ugly testimony to how little we care about others.

Wednesday, February 25, 2015

I quote from the article in The Economist that is the source of this chart:

FOR many Latin Americans the 21st century has been a time of unprecedented progress. Between 2002 and 2013, 60m people in the region moved out of poverty. The poverty rate—the share of people living on less that $4 a day—fell steadily. Now the progress has stopped (see chart). For the past three years, the poverty rate has stayed stubbornly at around 28% of the population, according to household surveys collated by the UN Economic Commission for Latin America and the Caribbean (ECLAC). The proportion that is extremely poor (with a daily income of less than $2.50) has edged up, to 12%.

I lived in Latin America as a Peace Corps Volunteer, paid at the poverty level, but I also had free medical attention, and an additional $75 per month enforced saving that came to me at the end of two years service. I was not dependent on my income to raise children (and my wife, another Peace Corps Volunteer, received equal pay to mine -- and two live better on two poverty wages than one does on one poverty wage). Trying to live a decent life on $4 per day would be really hard. I think it would be impossible on $2.50 a day in Latin America.

It is really worrisome that progress on alleviating poverty has stopped, especially as the global economic system has not really been all that bad in the last few years.

An article in The Economist predicts that hybrid cars are going to increase market share worldwide as are all electric cars at the expense of all fossil fuel cars. Electric motors for automobiles will replace internal combustion engines (I guess) as battery technology improves and as fossil fuels become harder to obtain and thus more expensive. The Economist seems to think it will take a long time for the shift to be completed.

In a previous post I mentioned my participation in a health planning research project in the early 1970s. Prior to that project, for a decade or more, the PAHO CENDES health planning method had been disseminated throughout Latin America; more than 2000 health officials had been trained in the method. While that had a beneficial impact of alerting many officials and health organizations of the need to do more, it seemed to yield few useful plans.

In all, I spent something like eight years thinking about health planning in developing countries as an occupation. I worked in a number of countries, visited others, and had colleagues who worked in still others and told me what they found. I noticed some interesting things:

Critical decisions were often about the construction of hospitals and health centers. Once built, these required staffing and budgets. The decisions seemed often to be political. In the Dominican Republic, for example, the dictator Trujillo had all the health centers built during his presidency built in the form of a "T" so that each would support his reign. Even when it was determined that a growing city needed a new public hospital, the decision of exactly where in the city would result in economic benefits for those who owned the land on which it would be built and indeed for those who developed surrounding areas and those who built the facility. I think the choice of location would then become political. So too, a newly elected legislator might try to get a health center approved and built in his district to bolster his chances of future election. A formal plan might not have much influence over such decisions.

Manpower allocations were less formal than one might think. Of course a new hospital or health center would have a table of organization with so many doctors, so many nurses, nursing aids, and other workers. But then there would come a need for a doctor in a hospital, and someone would tell a doctor on the nominal staff of another hospital to go work where he was more needed; no formal changes would be made in the staffing pattern. Then there was corruption. For example, a senior official would issue instructions that someone be added to the staff roll of a regional hospital even though he was living in the capitol city or in another country, with no medical responsibility at all. The formal written plans simply didn't catch up or didn't count.

I found a major, apparently modern hospital that did not have a modern cost accounting system. The heads of departments knew the direct budgets of their departments, and the senior staff knew all the direct costs. However, there was no accounting of indirect costs. For example, the internal medicine department knew the number of patients it treated and the costs of the salaries of its staff, but did not know how much the drugs it prescribed, nor the lab tests it ordered, nor the x-rays it ordered cost the hospital. Thus there was no way that total costs per service could be monitored, much less controlled.

Students I taught did a study of Ministry of Health pharmacies in our region. They discovered that a significant portion of the prescriptions sent to those pharmacies could not be filled because the required drugs were not in stock; on the other had, a significant portion of the stock languished on the pharmacy shelves for very long periods since it was not in demand. There was no adequate system for managing the inventory and ordering of drugs. In another country, having lunch across the street from a hospital, I watched as a shipment of pharmaceuticals was delivered, and then as another truck pulled up and reloaded the pharmaceuticals; I was told that they would be delivered to a private drug store to be sold on the open market. In still a third country, a consultant we had hired to look at pharmaceuticals quit informing us that he had had threats against his life, and that apparently the organized illicit drug industry also controlled the local pharmaceutical wholesalers.

You can see that in systems with such gross malfunctions, health plans based on a theory of efficiently meeting health needs had little chance of being implemented. If a system is not well managed, it is not likely to be well planned.

A Counter Example

The USAID mission in the Dominican Republic was interested in the possibility of a health sector loan to that country. I was working in the Office of International Health at the time, and we were asked to help them look into that possibility. We had in process a desk study of the DR health sector which avoided going in cold.

We agreed with the mission to help conduct an assessment. A senior academic in the DR was selected to head the assessment team, which he recruited. We provided (Spanish speaking) consultants from the United States. The assessment looked at the health conditions, the health services and the things that had worked and had not worked in the DR health sector reform in the past.

The assessment identified a major unmet health need. There was very high infant and child mortality in the rural areas. It seemed that a rural health service focusing on immunizations, health education, and identification and referral of health emergencies in the target population of young children could do some real good and be affordable. The service could be based on community health promoters and delegated medical functions to auxiliary health workers. Political and administrative constraints likely to be encountered were identified, and alternative measures considered to resolve them.

In preparing the USAID project documents, in cooperation with assessment team members, we developed a preliminary design for a rural health service, a preliminary plan of action, and a basic budget to cover the projected costs. The project was approved by the DR government and USAID.

Very fortunately, Dr. Amiro Perez, the very man who had led the health sector assessment and participated in the planning of the loan, was named Minister of Health as the project began. He made the development of the rural health service a priority of his administration, having fully mastered all aspects of the assessment on which it was based and its planning. He recruited his deputy on the assessment to help manage the development and administration of the rural health service.

Five years later, Dr. Perez was able to report that the mortality rate in children under the age of five years in the rural area of the Dominican Republic had been cut in half as a result of the action of the new rural health service.

Monday, February 23, 2015

The world map reprinted here is a reflection of more than 300,000 medical incidents which were reported in 2014 by companies to International SOS, which specializes in health care and emergency services to clients with business travelers overseas. Based on that data, a panel took into account threats of infectious disease, hygiene and sanitation, frequency of accidents and the availability and quality of the local health infrastructure to determine how risky a trip to a particular country might be.

I suspect that the map reflects the risks faced by visitors and expats in these countries and that the risks faced by native residents might be different. The risks faced by the poor are often worse than those faced by those with more resources (who can use those resources to reduce or ameliorate consequences of risks).

Saturday, February 21, 2015

According to this chart from The Economist, by 2050 the three largest countries in the world by population will be in order: 1. India, 2. China, and 3. Nigeria. No European countries are forecast to remain in the top dozen, which will be dominated by Asian countries with a few African and American nations completing the list.

These results are based on Gallup Daily tracking interviews throughout 2014 with 177,030 U.S. adults, and reflect those who say "at least once a week" when asked, "How often do you attend church, synagogue or mosque -- at least once a week, almost every week, about once a month, seldom or never?" Church attendance self-reports are estimates, and may not reflect precise week in and week out attendance, but provide an important measure of the way in which Americans view their personal, underlying religiosity. In particular, the focus on the top category of "weekly" attendance yields a good indicator of the percentage of each state's population that is highly religious, and for whom religion is likely to be a significant factor in their daily lives.......

The state-by-state variations in church attendance are significant because attendance is a powerful indicator of underlying religiosity, which in turn is related to Americans' views on life, culture, society in general and politics. For most segments of U.S. society -- blacks being the exception -- those who are the most religious are also most likely to be Republican, which helps explain the significant relationship between states with the highest church attendance and those that are traditionally red states. Church attendance also provides ties that bind members to their communities, and research shows that at the individual level, those who are most religious have higher well-being than those who are less religious.

Utah has the highest rate of churchgoing residents, attributed to the large Mormon population and the high rate of church service attendance among Mormons.

Nationwide, the creative class totals more than 40 million workers, more than a third of the total workforce, including professionals in the fields of science and technology, design and architecture, arts, entertainment and media, and healthcare, law, management and education.

I was a member of a health planning research project in the early 1970s. A WHO expert from Geneva at that time told me that for centuries after the fall of Rome, the largest cities were limited to about half a million inhabitants. At that size a city in the dark ages had a death rate that was so high that immigration and the birth rate could not be its equal, and the city would stop growing.

I don't know why Rome was so much larger at its peak that it was later or than were other European cities at a later date. There were possibly many reasons. The Romans were great engineers and had aqueducts that provided abundant water as well as sewerage to remove human wastes, leading to better hygiene than was possible in later centuries; perhaps the inhabitants of Rome were less often sick from water borne or water washed diseases. The Romans imported food in large amounts and distributed food to poor citizens, so perhaps the population was better nourished. The Romans brought slaves into Rome, and perhaps they brought in slaves faster than the slaves left and died.

In those days as a health planner I helped a small group of students do a senior project studying several alternative locations for a hospital to be built in Cali, Colombia -- the city in which we lived and the health planning project was located. The students developed a model based on the number of patients seeking cared for at each of the existing hospitals; the model was then used to predict how many would go to a new hospital were it located at each alternative place and what that flow would mean in terms of demand at the existing hospitals. (The study proved to be useful and used, and all the students involved were hired by the offices of the Ministry of Health in the Department of Valle.)

Cali, like many cities in developing countries, grew fast and had very different neighborhoods. I lived in one that had all the amenities of a U.S. or European city. There were neighborhoods that had minimal infrastructure, shacks, and high population density. (I remember someone calling those neighborhoods full of soil scrapers, making the word play on sky scrapers -- they had the population per acre you might expect in a neighborhood of sky scrapers, but the shacks barely rose above the soil on which they stood.)

It is too bad we didn't develop a model that would predict health status by neighborhood, leading to applications for prediction of demand on health service facilities (were they to be built), as well as an aid for the planning of infrastructure investment.

The epidemic of Ebola in West Africa suggests how useful a model might be that used housing quality, population density, a the availability of piped water and waste disposal facilities to enable quick prediction of the course of an epidemic and "hot spots".

Natalia Bronshtein, a professor and consultant who runs the blog Insightful Interaction, used data from the Siri Arms Transfer Database to map all major transfers of conventional weapons in 2013. Russia is the largest player, exporting $8.23 billion in arms that year, while the U.S. follows behind with $5.99 billion. China is a distant third, exporting $1.83 billion in 2013. You can view the interactive, which lets you hover over a country connection to see the details, here. Republished courtesy of Natalia Bronshtein.

Basically, Russia, the USA and to a lesser extent supply arms to the world.

Wednesday, February 18, 2015

I quote extensively from the article in The New York Times (go to the original for the interactive map):

(The map is based on) six data points for each county in the United States: education (percentage of residents with at least a bachelor’s degree), median household income, unemployment rate, disability rate, life expectancy and obesity. We then averaged each county’s relative rank in these categories to create an overall ranking........

The 10 lowest counties in the country, by this ranking, include a cluster of six in the Appalachian Mountains of eastern Kentucky (Breathitt, Clay, Jackson, Lee, Leslie and Magoffin), along with four others in various parts of the rural South: Humphreys County, Miss.; East Carroll Parish, La.; Jefferson County, Ga.; and Lee County, Ark........

Six of the top 10 counties in the United States are in the suburbs of Washington (especially on the Virginia side of the Potomac River), but the top ranking of all goes to Los Alamos County, N.M., home of Los Alamos National Laboratory, which does much of the scientific work underpinning the U.S. nuclear arsenal. The lab directly employs one out of every five county residents and has a budget of $2.1 billion; only a fraction of that is spent within the county, but that’s still an enormous economic engine for a county of just 18,000 people.

Here are some specific comparisons: Only 7.4 percent of Clay County residents have at least a bachelor’s degree, while 63.2 percent do in Los Alamos. The median household income in Los Alamos County is $106,426, almost five times what the median Clay County household earns. In Clay County, 12.7 percent of residents are unemployed, and 11.7 percent are on disability; the corresponding figures in Los Alamos County are 3.5 percent and 0.3 percent. Los Alamos County’s obesity rate is 22.8 percent, while Clay County’s is 45.5 percent. And Los Alamos County residents live 11 years longer, on average — 82.4 years vs. 71.4 years in Clay County.

The poorest parts of the country are the old south and Appalachia. The California coast and the eastern seaboard do well. I note that there is a big blue area (doing quite well) in the northern mid-west, what I think of as the agricultural heartland of the country. The orange areas included in that blue are likely to have large Indian reservation populations. The counties there are big, suggesting that when they became states they were sparsely populated, and I suspect they still have relatively few members of the House of Representatives per Senator. These would be Republican heartland (see map below), benefiting from strong government support for agricultural interests.

I am not sure that the poor counties of the south are natural political allies for the better off counties of the Dakotas, Nebraska, Montana and Wyoming.

Though passion may have strained it must not break our bonds of affection. The mystic chords of memory, stretching from every battlefield and patriot grave to every living heart and hearthstone all over this broad land, will yet swell the chorus of the Union, when again touched, as surely they will be, by the better angels of our nature.
Abraham Lincoln, First Inaugural Address

My last post asked if Texas will remain Texas in the future in spite of all the changes that will come to the state. I believe the question was meant to be, will the people living in Texas in the future share the values of the people living there now. My guess is that people in Texas today do not all share the same set of values, nor will they in the future, but that the dominant values in the future will differ from those of today. Indeed, one of the lessons from the study of history is that the past is a different country, and we should not judge people of the past by today's standards.

I quote President Lincoln for a couple of reasons. One is that 150 years ago President Lincoln believed that "the better angels of our nature" would come to the fore, and that people who sought to secede from the Union would again "swell the chorus of the Union". There are people in Texas who still call for secession from the Union (and people elsewhere who would let them go).

The other reason is to suggest that there are devils of our nature as well as angels, and that both seem to weigh in on changes in values. The Civil War freed the slaves but Jim Crow came to replace chattel slavery, especially in the South. The work ethic led to prosperity, but the nation suffered once and suffers again from a acquisitive class that most of us feel appropriates far more than its fair share of the income and wealth of the nation.

Today we have red and blue states and culture wars. However our values evolve, I would bet that there will be some people longing for the good old days when -- according to their beliefs -- people had better values. I would also bet that there will be people hoping for a better future when people will at last achieve the nation that -- according to their beliefs -- was implicit in the hopes and dreams of the founding fathers.

Monday, February 16, 2015

Yesterday I watched a televised talk by Richard Parker about his book Lone Star Nation: How Texas Will Transform America. In that talk he described massive changes that will occur in the state, from increased urban population, migration from the rest of the United States to the triangle formed by Huston -- San Antonio and Dallas-Fort Worth, increase in the portion of the population of Hispanic ancestry, changes in the religious makeup of the population, and changes in the economy of Texas, the nation and the world. Then he addressed the question, will Texas remain Texan?

This year marks the 60th anniversary of my graduation from high school. A decade ago I returned to Los Angeles to meet with five of my close friends from high school for a mini-reunion. It was an interesting experience. On the one hand, I drove past the school and the house I lived in when I was in high school and they were both there, although they seemed smaller than I remembered them. On the other hand, the culture of the neighborhood seemed to have changed a great deal. Indeed, California had changed a great deal (I had lived out of the state for more than 40 of the 50 years, but California continues to make news.) Perhaps you need to be old to perceive how much things change.

Texas today is not the same as it was when it was inhabited only by Indians, nor when it was part of Mexico, nor when it was the Lone Star Republic, nor when it was thought by its inhabitants to be one of the states of the Confederate States of America. It is not the same as it was in the reconstruction, nor in the depth of its Jim Crow past. Why should it be the same a half century in the future as it is now?

On the other hand, Texas culture today bears legacies from its history as Texas in the future will almost certainly bear legacies from today.

I think of the United States as a whole. We benefit from the political legacy of Washington, Madison, Jefferson, Jackson and Lincoln; we benefit from the economic legacy of centuries of investment in the nation's productive capacity and economic institutions. On the other hand, we suffer from the racist legacy of slavery and Indian wars and removals; we have perhaps been too warlike a people. The question is whether we will listen to the better angels of our nature to achieve a more just, more perfect society; alternatively we may fall back to evils of the past or discover new evils in which to indulge ourselves/

So too, Texas may become more Texan as it evolves in the future. (Some would dread that possibility.) It may become more like the rest of the country, or it may evolve into something really new.

Friday, February 13, 2015

People in emerging and developing countries around the world are on balance unhappy with the way their political systems are working. A recent Pew Research Center survey finds that, across 31 emerging and developing nations, a median of 52% are dissatisfied with their political system, while 44% are satisfied.......

Political satisfaction is frequently related to economic attitudes. Countries where the economic mood is negative also have high levels of unhappiness with the political system.......In every country surveyed, people who describe the current economic situation as bad are especially likely to express dissatisfaction with their political system.

In addition to being dissatisfied with their political system, a median of 64% across the 34 emerging and developing nations surveyed say that higher-income people have too much influence in their political system.

These statements correspond to my intuition, but there is a big difference between what I might think and what capable researchers conclude from the data that they have concluded. Check out the article itself with its interactive graphics.

Thursday, February 12, 2015

Today is the 206th anniversary of Charles Darwin's birth. It is also the 206th anniversary of the birth of Abraham Lincoln, but this post is about American opinion with respect to evolution. It is based on a report from the Pew Research Center.

A solid majority (64%) of white evangelicals in a 2013 poll said that humans and other living things have always existed in their present form, while only 27% said that humans evolved. These views are largely mirrored by the positions of large evangelical churches, such as the Southern Baptist Convention and the Lutheran Church-Missouri Synod, which explicitly reject evolutionary theory as being in conflict with what they see as biblical truth.

Let me distinguish two situations:

Someone understands the theory of evolution reasonably well, understands that the vast majority of scientists accept evolution as real, but knows also that the leaders of the religion to which he belongs reject the theory of evolution. That person feels that his faith in his religion requires that he believe its view of creation.

Someone does not understand the theory of evolution, has little idea of the evidence that supports the theory, and thinks that scientists are divided on the validity of evolution. The person knows also that the leaders of the religion to which he belongs reject the theory of evolution. That person accepts the view of the leaders of his religion, and believe the religion's dogma on creation.

I much prefer people who correspond to situation one. Such a person has accurate knowledge of the theory and its acceptance by the scientific community and simply chooses not to "believe" in it.

As to the teaching of evolution and its alternatives, I quote again:

In spite of efforts in many American states and localities to ban the teaching of evolution in public schools or to teach alternatives to evolution, courts in recent decades have consistently rejected public school curricula that veer away from evolutionary theory. In Edwards v. Aguillard (1987), for instance, the U.S. Supreme Court ruled that a Louisiana law requiring public school students to learn both evolution and “creation science” violated the Constitution’s prohibition on the establishment of religion.

Clearly appropriate science courses in the USA should teach evolution. That is the law. It is also the consensus of the vast majority of scientists as to what should be taught as science. Indeed, it is a basis for understanding much of biological science.

Private schools run by religious organizations can of course include courses on the dogma of their religion.

I also see a role to have courses on teaching "information literacy" -- the skill of discerning the credibility of information that one encounters from different sources. The evolution-creationism situation seems tailor made for getting students to think seriously about in what sense scientific theories are credible and in what sense religious teachings are credible. Unfortunately, I doubt that many K-12 teachers are capable of teaching such a complex topic well.

Wednesday, February 11, 2015

I have been reading The Scramble for Africa: White Man's Conquest of the Dark Continent from 1876 to 1912 by Thomas Pakenham. (See my previous post.) I am struck by how recent it was that the imperial powers divided Africa among themselves -- basically a 40 year period (ending with the transfer of the German colonies to the victors of World War I). The following maps show a great deal about the process in which the imperial powers moved out from their footholds on the coast of Sub-Saharan Africa to control the interior, and as the European imperial powers took over control of North Africa from the dying Ottoman Empire.

As late as 1876, European empires controlled limited areas on the coast of Africa. The Ottoman empire still held nominal sovereignty over a large area of north Africa and the Nile River valley and the related areas of Egypt and the Sudan. Muslim traders and slavers controlled an area in the east, notably the areas shown as controlled by the Sultanate of Zanzibar (see my related post).

By 1912, European empires controlled almost all of Africa, with Germany holding large areas in east Africa and south west Africa, areas it was to lose as a result of World War I. Madagascar, although not so shown on the map, was French at this point.

By 1920 France (blue) now has a huge holding in north-west Africa and Madagascar. Britain (red and pink) controls a band from the southern tip of Africa up through east Africa to and including Egypt with holdings in the west including Nigeria, the Gold Coast and Sierra Leone. Portugal (dark green) holds Angola and Mozambique, but much expanded inland from the territory it controlled in 1876. Italy (light green) holds Somaliland, Eritria and Lybia. Spain (yellow) holds small colonies close to Spain itself. Only Liberia (ruled by repatriated blacks from America) and Ethiopia (the areas in grey) remain independent of European imperial control.

After World War II there was a wave of decolonization leading to independence for the African nations. However, many of the boundaries created by the European empires remained as boundaries of modern African states.

Since the European imperial powers didn't consider the tribal origins of the people living in the areas that they grabbed in the scramble for Africa, today many ethnic homelands are divided by national borders left over from the days of imperial colonization.

Tuesday, February 10, 2015

There is an article in The Economist about the use that was made of quantitative models to forecast the incidence of Ebola in the current West African epidemic.

With more than 22,000 people infected, nearly 9,000 of whom died, this outbreak was the gravest ever. But it confounded experts who had feared much worse. In September the WHO predicted more than 20,000 cases by November (there were actually about 13,000). Around the same time, a worst-case prediction by America’s Centres for Disease Control and Prevention (CDC) of up to 1.4m cases (reported and unreported) by January 20th made the headlines. Others were similarly bleak. So where did models and reality diverge?

For a start, the models relied on old and partial figures. These were plugged into equations whose key variable was the rate at which each case gave rise to others. But this “reproduction number” changed as outside help arrived and those at risk went out less, avoided physical contact and took precautions around the sick and dead. So difficult are such factors to predict that epidemiologists modelling a disease often assume that they do not change at all.

I suspect that the authors of this article misunderstand the nature of disease models. One interpretation of such models is as "if, then statements". If the parameters of the model are correct, and if the relations implemented in the equations of the model are correct, then the model's predictions are likely to be correct. A logician will tell you that in such statements, when the if statements are not correct, then no conclusions can be drawn.

Indeed, very often models are used with different parameters to show how different are the conclusions that follow from them. Thus

(For the CDC projections) it was the “very unlikely” worst-case scenario that grabbed the headlines. This assumed not only a stable reproduction number, but that known cases were just 40% of the total (based on the gap between the baseline model and figures for the number of people in treatment on a single day in August).

That is, the worst case scenario studied by the CDC was that each case of Ebola would generate as many new cases as the first ones did, continuing an exponential growth month after month. Moreover, it assumed that the origin of the epidemic in rural villages and the distrust of authority in those villages were such that the number of initial cases that actually came to the attention of medical authorities would only be three for every five people infected.

How does one obtain a parameter for the number of cases that officials don't know about? One guesses. Normally, one would run the model with different values to show a range of possible projections.

Similarly, epidemiologists are not naive; they know that over time people will learn to reduce the new infections per ill person. But how do the estimate the way this parameter will change over time? They guess. Again, it is common to do several projections with different scenarios for the reduction in the reproduction number -- the number of people on average to which each infected person passes his infection.

Indeed, one of the key uses for modeling of epidemics should be to help manage the public health effort in response to the epidemic. How much effort should be devoted to general health education? how much to keeping friends and neighbors from touching people sick with Ebola or their bodies after they die? How much to having teams bury the victims using full isolation and protective methods? The costs of each alternative can be compared with its likely effectiveness.

Ebola was poorly understood. There had been only a couple of dozen previous outbreaks, all in remote areas, all with small numbers of victims, and all with slightly different strains of the virus, one from another. Thus, it was only in this much larger epidemic was it learned that people ill from the disease became much more infectious as the disease progressed; thus only now can epidemiologists begin to quantify the advantage of early identification and isolation of people infected with Ebola.

The public health approach is now changing. At one point there were 1000 or more people being infected each week. The staff was still gathering and tooling up, and were running as fast as they could to educate the public, build trust, identify the new cases and get them into care, to train staff in procedures to limit infections in care facilities, and to bury the dead safely. Now that the incidence is much lower, the officials are going to greatly expand the effort to trace the contacts of each person who comes down with the disease, quarantine those contacts, and stop the chain of infections. As long as the disease is being transmitted, there is a possibility of an epidemic exploding again.

There was once a global campaign to eradicate malaria. It proved impossible to do so, and the small numbers of malaria victims in the countries from which it was not eradicated reinfected the world. Today we are near the global eradication of polio. However, there are a few focal spots left that could serve as the source to reinfect the world; indeed, we were very close to eradicating the disease a few years ago, but there was resistance to the immunization campaigns leading to continuing new cases; when some of these ill persons traveled, they reintroduced the disease into other countries.

There is an interesting article in Foreign Policy magazine titled "Why Arming Kiev Is a Really, Really Bad Idea" by Harvard International Relations Professor Stephen Walt. It suggests that there are two different kinds of aggression in foreign policy:

Sometimes states act aggressively because their leaders are greedy, seeking some sort of personal glory, or ideologically driven to expand, and are not reacting to perceived threats from others. The classic example, of course, is Adolf Hitler and Nazi Germany, and in such cases accommodation won’t work. Here the “deterrence model” applies: the only thing to do is issue warnings and credible threats so that the potential aggressor is deterred from pursuing its irrevocably revisionist aims.

By contrast, the “spiral model” applies when a state’s seemingly aggressive policy is motivated primarily by fear or insecurity. Making threats and trying to deter or coerce them will only reinforce their fears and make them even more aggressive, in effect triggering an action-reaction spiral of growing hostility.

So which of the models is more applicable to Putin's Russia? (Of course, Putin's Russian support for aggression in Ukraine may be based on a mixture of both Hitlarian aggressiveness and fear and insecurity; they may also be -- perhaps partly -- motivated by other factors, say Putin's concern for his domestic base which can be manipulated by nationalism and fear of the West.)

I recently read a history of Ukraine and posted some thoughts (see Ukraine: the Borderland). As we think about U.S. and E.U. policy with respect to the current Ukrainian crisis, it is well to think about the country itself and its leadership. Is the leadership strong enough and "worthy enough" to invest in? Certainly the government has been changed by popular demand a couple of time in the couple of decades since independence, and there has been a great deal of government corruption in that time.

A majority of Ukrainians are satisfied with Poroshenko’s handling of relations between Ukraine and the EU (52%) and media rights and freedoms (51%); however, few expressed satisfaction with his handling of a number of key issues, such as the conflict in the East (15%), corruption (11%), inflation (6%) and job creation (6%). These perceptions are reflected in the widely held belief that the overall situation in the country has gotten worse in the past six months. Outside Donbas, 69 percent believe that that the overall situation is somewhat or definitely worse, while 15 percent believe the situation is better and 9 percent believe the situation has not changed in the past six months. In Donetsk, 94 percent believe the situation is definitely or somewhat worse. These numbers are largely driven by a perceived decline in economic conditions (55%) or political stability (36%). Over the same period, a number of Ukrainians see improvement concerning the unity of citizens (45%), respect for citizens’ rights by authorities (31%) and maintenance of law and order (25%).

Ukraine, as it was created in the breakup of the USSR was ethnically diverse. As the maps above indicate, many of the people living in the east of Ukraine have Russian ethnic roots, and their political preferences are different than those in the rest of the country. I also recently posted on the difference between a civic state and a national state. As Putin's Russia absorbed Crimea and is supporting separatist movements of native Russian speakers in eastern Ukraine, it may be that nationalism is also involved in the crisis -- a subgroup of people believing themselves to be ethnic Russians having been placed in Ukraine by a historical accident seeking to live in a more Russian state.

I am glad that others more knowledgeable than I will have to make the decisions on U.S. policy. I hope they understand the situation, that they get advice from a variety of informed sources, and that they do the right thing. It seems to me that it will be hard to find the right policiy balancing the interests of the various Ukrainians, the Russians, the western Europeans and the Americans.

UNESCO was created to build the defenses of peace in the minds of men. It seems obvious now that those defenses have to include defenses against racism, since all too often men have mentally constructed racial differences and then used them as a rationale to break the peace. Perhaps that lesson, though less widely shared in 1945, was all the more vivid in the minds of those creating UNESCO in the wake of World War II and the Holocaust!

Carl Djerassi was I suppose best described as a polymath. His career as a chemist was distinguished: he synthesized the chemical that made the first birth control pill possible.

He developed synthetic juvenile hormone in insects, preventing them becoming adults, for non-toxic control of mosquitoes and fleas, developed corticosteroids for inflammation—steroids had been a passion since the 1940s—and devised a way of detecting opiates in urine, used by the army in Vietnam.

He was a professor of chemistry at Stanford University for many years. As an entrepreneur and expert in research management, he ran two research companies while on the Stanford Faculty. He owned a California winery that produced fine wines. He was an art collector. Later he wrote novels and plays.

I knew him as a man who cared about the poor in poor counties and was willing to devote time and effort to advising the government on how to use science and technology to better the lot of these people; he did so without pay.

I remember others associated with BOSTID, including George Bugliarello, Roger Revelle, Frederick Seitz, E.O. Wilson, Hugh Popenoe, John Gibbons, Joshua Lederberg and Frederick Robbins. Offhand I can think of two Nobel Prizes and two Pulitzer Prizes among these eight people. For those who have thought that leaders in fields of science and technology live in "ivory towers", knowing any one of these men would be a revelation. Each was brilliant in his own field of specialization, each had many skills, and each cared enough about the poor and needy to devote time and effort to their aid.

Thursday, February 05, 2015

As I understand its history, U.S. aid was created in part to allow allied countries that needed U.S. goods and services to obtain them even though they did not have the dollars to buy them. Thus it made sense to use the U.S. aid dollars to buy the goods and services here and send them to the countries in need.

Of course, the funding for USAID is appropriated by the Congress through a political process. Rice growers, beltway bandits and others who found selling goods and services to the foreign aid program lobbied for funding to be earmarked for their goods and services. Shipping on "American bottoms" seems a case in point -- food aid from the USA shipped under foreign aid has to be shipped on U.S. owned cargo ships, even when it might be better to use other carriers.

It is now well publicized that the richest people in the United States are appropriating more and more of the nation's wealth. I quote from the article which was the source of this graph:

In recent decades, only a tiny fraction of the population saw its wealth share grow. While the wealth share of the top 0.1 percent increased a lot in recent decades, that of the next 0.9 percent (families between the top 1 percent and the top 0.1 percent) did not. And the share of total wealth of the “merely rich”—families who fall in the top 10 percent but are not wealthy enough to be counted among the top 1 percent—actually decreased slightly over the past four decades. In other words, family fortunes of $20 million or more grew much faster than those of only a few millions.

The flip side of these trends at the top of the wealth ladder is the erosion of wealth among the middle class and the poor. There is a widespread public view across American society that a key structural change in the U.S. economy since the 1920s is the rise of middle-class wealth, in particular because of the development of pensions and the rise in home ownership rates. But our results show that while the share of wealth of the bottom 90 percent of families did gradually increase from 15 percent in the 1920s to a peak of 36 percent in the mid-1980, it then dramatically declined. By 2012, the bottom 90 percent collectively owns only 23 percent of total U.S. wealth, about as much as in 1940

The income of the rich has also increased since the 1970s, but the top 0.1 percent appropriates less than 10 percent of total income, while the top 0.1 percent now holds more than 20 percent of wealth. (Of course, some of the people in the top income bracket are not in the top wealth bracket, and some of the people in the top wealth bracket are not drawing huge incomes from that wealth).

The point is, the increase in stock prices and the value of other investments has been huge over time. In other countries there are taxes that effectively reduce the rate of growth of the wealth of the very wealthy. Apparently since the Reagan revolution, in the United States these mechanisms are not so effective.

I quote from the Pew Research Center report from which the above graph is drawn:

Our analysis is based on household income data from the U.S. Census Bureau. First, we adjust incomes for family size. Incomes of households of below-average size are scaled up (because their dollars go farther), and incomes of households of above-average size are scaled down (because their dollars do not go as far). This process ultimately adjusts household incomes to reflect the standard of living of a three-person household.

Finally, we compute the median of the size-adjusted household incomes. Middle-income households, by our definition, earn as much as twice the median income or as little as two-thirds the median. This results in a range of $40,667 to $122,000 for a middle-income American household of three in 2013.

And:

In the years following the Great Recession, the share of Americans who live in middle-income households held steady at 51% in 2013, the same share as in 2010, according to a new Pew Research Center analysis.

While the muddled recovery has yet to bolster the middle, this flat trend might actually be good news because, for now, it stems a decades-long slide. Back in 1970, 61% of adults lived in middle-income households.

The basic point is that middle class Americans were seeing their income increase from the 1970s to 2000, albeit not as quickly as those in the top income brackets. However, there were fewer families in this group with incomes from 2/3rds to twice the median income. Moreover, these middle incomes in 2013 were less than they had been in 2000. Of course it is not the same families, but the trends are very disturbing.

The map, based on pay data from more than 18,000 internists, shows striking geographical disparities. Rural medics make more, because few doctors want to live in the boondocks. Pay is lower in fashionable neighbourhoods: a doctor of general medicine in New York typically earns 64% less than his peer in Alabama. The lowest pay is in Massachusetts, which has four medical schools and a surplus of stethoscope-slingers.

I quote from the article in The New York Times from which I drew this map (the source is an interactive graphic):

The towns and counties where the lowest share of men between the ages of 25 and 54 are employed tend to be some of the tougher places in the United States to live, including Appalachia, Northern Michigan, the Deep South and the interior Southwest.

The places with low levels of female employment have a lot of overlap with these high-poverty places, as an Upshot analysis of census data shows. That’s hardly surprising: Lack of employment has a strong and obvious correlation with poverty. Yet the geographic patterns of female work also have more nuances than the male patterns.

Female employment rates are relatively low in some fairly affluent areas, including Utah and other heavily Mormon areas — as well as on the Upper East Side of Manhattan. The East 80s and the suburbs of Salt Lake City may be very different places, but both have local cultures with a bent toward stay-at-home parenting, which still is far more likely to be done by mothers. In this way, they are extreme examples of a national trend: a modestly increased interest in full-time parenting in recent years.

I was struck by the deep South, where jobs are scarce, but doctors make relatively high rates of pay. Doesn't seem fair does it?

Wednesday, February 04, 2015

Friluftsliv: the Norwegian concept that being outside is good for human beings' mind and spirit.

Shinrin-yoku: a Japanese term that means "forest bathing": The idea being that spending time in the forest and natural areas is good preventative medicine, since it lowers stress, which causes or exacerbates some of our most intractable health issues.

Wabi-sabi: the Japanese idea of embracing the imperfect, of celebrating the worn, the cracked, the patinaed, both as a decorative concept and a spiritual one.

Jugaad: a Hindi word that means "an innovative fix" or a "repair derived from ingenuity,"

Some words from other languages clearly convey feelings that I have had that are hard to convey in English. Susto from the Spanish is another such word.

New Pew Research Center surveys of citizens and a representative sample of scientists connected to the American Association for the Advancement of Science (AAAS) show powerful crosscurrents that both recognize the achievements of scientists and expose stark fissures between scientists and citizens on a range of science, engineering and technology issues.

79% of adults say that science has made life easier for most people and a majority is positive about science’s impact on the quality of health care, food and the environment.

54% of adults consider U.S. scientific achievements to be either the best in the world (15%) or above average (39%) compared with other industrial countries.

92% of AAAS scientists say scientific achievements in the U.S. are the best in the world (45%) or above average (47%).

About seven-in-ten adults say that government investments in engineering and technology (72%) and in basic scientific research (71%) usually pay off in the long run. Some 61% say that government investment is essential for scientific progress, while 34% say private investment is enough to ensure scientific progress is made.

However:

Only 16% of AAAS scientists and 29% of the general public rank U.S. STEM education for grades K-12 as above average or the best in the world. Fully 46% of AAAS scientists and 29% of the public rank K-12 STEM as “below average.”

75% of AAAS scientists say too little STEM education for grades K-12 is a major factor in the public’s limited knowledge about science. An overwhelming majority of scientists see the public’s limited scientific knowledge as a problem for science.

The public's general support for science is reassuring, but the differences between public views and those of the scientific community (shown in the figure above) are sometimes of concern.

I have spent time looking at biotechnology, and I know from experience that the scientific community is very careful to assure the safety of foods that are produced from genetically modified crops. The public is I fear unaware of the dangers of traditional breeding, and too fearful of biotechnology. Of course, we need to continue to assure careful vetting of GM research and releases of GM crops, but the public fear is excessive.

Similarly, while I worked for many years to assure that animals involve in the research programs I managed were treated ethically, I also recognize that their use was necessary. There is no question that ethical use of animals in research is justified by the benefits such research yields for mankind.

Evolution is central to modern biological science, and the evidence for evolution is overwhelming. I don't mind what people believe, but I do mind when people insist that children's science classes not teach scientific consensus.

The fear of vaccines is unjustified, and as the current measles epidemic shows, that fear leads to very serious consequences. While the MMR vaccine is very safe and very effective, the most recent data from the World Health Organization indicated that there were 145,000 deaths from measles in 2013. While measles was eradicated from the USA years ago, if Americans don't immunize their children, the disease can be reintroduced from Africa and Asia, where it is endemic in many poor countries.

Similarly, the vast majority of scientists are convinced that humans are driving global warming through activities that cause increase in the release of greenhouse gases. I fear that the public has bought a false story from those who profit from businesses releasing those greenhouse gases (and the folk that they fund). Prudence demands that we act globally and quickly to reduce greenhouse gas emissions.

It is not having more people in the world that is a problem per se, it is that more people with higher expectations for their lives put more stress on the environment. That makes is harder and harder to feed the billions of people and provide them all with decent lives. Global warming, pollution of land, air and water, deforestation, desertification, loss of biodiversity are only the most worrisome of the problems likely to arrive with the population increases we still expect.

Obviously the ACLU has selected carefully to find the best, most widely loved books that have been banned. I suspect that having been banned does not necessarily mean that a book is in this class.

I suspect that many of the people who have banned these books are simply unable to appreciate good writing, and indeed that many of them have not read the books that they hate. I also suspect that others ban books, not to protect the public, but to protect themselves from the possibility that the public will learn to think thoughts that the censors feel threaten themselves.